A Case Report of Autoimmune Encephalitis: Could Post-COVID-19 Autoimmunity Become a Lethal Health Issue?

Abstract

While it is primarily thought of as a respiratory illness, COVID-19 is now recognized as a multi-organ disease that can present with a wide range of clinical manifestations. Particularly in patients with severe respiratory illness, neurological manifestations ranging from headaches, and loss of smell to strokes have been associated with the virus. In the setting of resolving respiratory illness, it is important to consider autoimmune encephalitis (AE) in the instance of new-onset neurological manifestations. The typical patient presentation includes altered mental status, fever, seizures, and/or focal neurological deficits. These neurological manifestations make it crucial to consider either underlying COVID-19 infection or post COVID-19 autoimmunity so as not to delay the administration of the appropriate treatment. Herein, we present the case of an 88-year-old female with new-onset right leg weakness, and dysarthria, that progressively developed to altered mental status months after having respiratory symptoms of COVID-19. According to the criteria of AE diagnosis, the patient's clinical course and work-up findings proved the diagnosis.

Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis

“…Several cases developed neurological impairment following respiratory symptoms. The latency between the onset of the infection with respiratory manifestations and the onset of neurological complications varied between 3 days and 41 days [ 12 , 24 , 27 , 28 , 30 , 32 , 34 , 36 , 37 , 43 , 45 , 51 , 56 , 58 , 64 , 65 , 70 , 76 , 80 , 81 , 82 , 83 , 85 , 86 , 89 , 90 , 91 , 93 , 94 ]. Overall, 13 patients were intubated and mechanically ventilated due to respiratory distress; in these cases, the detection of neurological impairment happened when sedation was interrupted, with latency ranging between 4 and 38 days depending on the case [ 27 , 32 , 34 , 76 , 80 , 82 , 85 , 93 ].…”

“…In patients whose respiratory distress was less evident, neurological manifestation appeared after a few days in most cases [ 27 , 28 , 30 , 37 , 45 , 56 , 58 , 65 , 89 , 91 , 93 , 94 ]. In some cases, the latency ranged from over two weeks to 60 days [ 12 , 24 , 27 , 64 , 90 ]. Three patients began their illness with symptoms other than respiratory and developed neurological impairments between 5 and 17 days after the onset of the initial symptoms [ 22 , 47 , 50 ].…”

“…Sleep disturbances, progressive altered mental status, psychiatric behavioural symptoms, and hallucination have been described by some authors [ 22 , 26 , 37 , 47 , 51 , 52 , 56 , 58 , 63 , 72 , 73 , 75 , 78 , 81 , 86 , 89 , 94 ]; most of these cases are associated with EEG representations [ 22 , 26 , 37 , 63 , 74 , 75 ], and some with brain neuroimaging alteration [ 51 , 52 , 56 , 78 , 81 , 94 ]. Neurological deficit referred to language deficit, cognitive deficits, akinetic syndrome with mutism, signs of cortical impairment, seizures, stroke, cerebellar signs, chorea, paralysis, coma, and signs of brain death [ 17 , 25 , 33 , 36 , 37 , 38 , 39 , 47 , 49 , 51 , 52 , 53 , 58 , 59 , 60 , 64 , 65 , 71 , 72 ,…”